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Mavyret — Highmark

chronic hepatitis C

Initial criteria

  • age between 3 and 17 years
  • diagnosis of acute hepatitis C (ICD-10: B17) or chronic hepatitis C (ICD-10: B18.2)
  • no prior HCV treatment
  • prescriber provides cirrhosis status
  • regimen is appropriate per FDA-approved labeling and/or AASLD/IDSA guidelines
  • prescriber attests member or parent/guardian has been educated on risks of alcohol or IV drug abuse
  • if the member has alcohol use disorder or is an IV drug abuser, prescriber attests an offer of referral for substance abuse treatment and care management was made